Provider Demographics
NPI:1912926163
Name:SIVILS, RITA (DO)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:SIVILS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 BERGER RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4703
Mailing Address - Country:US
Mailing Address - Phone:813-962-4159
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:2025 INDIAN ROCKS RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1035
Practice Address - Country:US
Practice Address - Phone:727-581-9474
Practice Address - Fax:813-972-5753
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7243207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57854OtherBC/BS OF FLORIDA
FL57854OtherBC/BS OF FLORIDA
FL57854WMedicare PIN
G03218Medicare UPIN